Motoric Cognitive Risk Syndrome: Multicountry Prevalence and Dementia Risk

OBJECTIVES: Our objective is to report prevalence of motoric cognitive risk syndrome (MCR), a newly described predementia syndrome characterized by slow gait and cognitive complaints, in multiple countries, and its association with dementia risk. METHODS: Pooled MCR prevalence analysis of individual data from 26,802 adults without dementia and disability aged 60 years and older from 22 cohorts from 17 countries. We also examined risk of incident cognitive impairment (Mini-Mental State Examination decline ≥4 points) and dementia associated with MCR in 4,812 individuals without dementia with baseline Mini-Mental State Examination scores ≥25 from 4 prospective cohort studies using Cox models adjusted for potential confounders. RESULTS: At baseline, 2,808 of the 26,802 participants met MCR criteria. Pooled MCR prevalence was 9.7% (95% confidence interval [CI] 8.2%-11.2%). MCR prevalence was higher with older age but there were no sex differences. MCR predicted risk of developing incident cognitive impairment in the pooled sample (adjusted hazard ratio [aHR] 2.0, 95% CI 1.7-2.4); aHRs were 1.5 to 2.7 in the individual cohorts. MCR also predicted dementia in the pooled sample (aHR 1.9, 95% CI 1.5-2.3). The results persisted even after excluding participants with possible cognitive impairment, accounting for early dementia, and diagnostic overlap with other predementia syndromes. CONCLUSION: MCR is common in older adults, and is a strong and early risk factor for cognitive decline. This clinical approach can be easily applied to identify high-risk seniors in a wide variety of settings

Prevalence and incidence of iron deficiency in European community-dwelling older adults: an observational analysis of the DO-HEALTH trial

Background and aim Iron deficiency is associated with increased morbidity and mortality in older adults. However, data on its prevalence and incidence among older adults is limited. The aim of this study was to investigate the prevalence and incidence of iron deficiency in European community-dwelling older adults aged ≥ 70 years. Methods Secondary analysis of the DO-HEALTH trial, a 3-year clinical trial including 2157 community-dwelling adults aged ≥ 70 years from Austria, France, Germany, Portugal and Switzerland. Iron deficiency was defined as soluble transferrin receptor (sTfR) > 28.1 nmol/L. Prevalence and incidence rate (IR) of iron deficiency per 100 person-years were examined overall and stratified by sex, age group, and country. Sensitivity analysis for three commonly used definitions of iron deficiency (ferritin  1.5) were also performed. Results Out of 2157 participants, 2141 had sTfR measured at baseline (mean age 74.9 years; 61.5% women). The prevalence of iron deficiency at baseline was 26.8%, and did not differ by sex, but by age (35.6% in age group ≥ 80, 29.3% in age group 75–79, 23.2% in age group 70–74); P  1.5. Occurrences of iron deficiency were observed with IR per 100 person-years of 9.2 (95% CI 8.3–10.1) and did not significantly differ by sex or age group. The highest IR per 100 person-years was observed in Austria (20.8, 95% CI 16.1–26.9), the lowest in Germany (6.1, 95% CI 4.7–8.0). Regarding the other definitions of iron deficiency, the IR per 100 person-years was 4.5 (95% CI 4.0–4.9) for ferritin  1.5. Conclusions Iron deficiency is frequent among relatively healthy European older adults, with people aged ≥ 80 years and residence in Austria and Portugal associated with the highest risk

Groundwater: medicine by the glassful?

Knowledge of the healing properties of some groundwater sources has been passed down through the generations. A complex array of hydrogeological environments yields a rich and diverse range of chemical compositions, and cures for a variety of ailments were available from some spring waters. Many were sourced with associated religious overtones. It is likely that exposure to clean cold water alleviates the symptoms of leprosy and probable also that it relieves rheumatic pain. However, the only demonstrable medicinal properties of groundwater are its purging effects wherever MgSO4 or Epsom salts prevailed. Clean and potable groundwater is certainly a key to human health and some of the minerals dissolved within it are essential to the human body, although many of these minerals become toxic if present in excess. The modern fashion for bottled groundwater, often perceived to be associated with health-giving and medicinal properties, for the most part, merely offer a safe form of drinking water. The curative and medicinal properties of groundwater have been recognized, correctly or otherwise, for several thousands of years. The founding of the English city of Bath, with its well-known spa waters, goes back to 863 BC when the young Prince Bladud contracted leprosy and was banished from his father’s royal court (Bowman 1998). He was set to work as a swine herdsman, but soon his pigs also caught the disease. But one day, when the pigs had been wallowing in a warm mud spring by the river, one by one they emerged from the mud with clear signs of healing. On seeing this, Bladud did likewise and he too emerged cleansed with greatly improved health. The Prince was able to return to his royal duties, later becoming the mythical God-King, father to King Lear, but, more importantly, making the link between groundwater and medicine. Many years later, Robert the Bruce would enjoy the same cure, this time at a spring emerging from Devonian sandstone at Scotlandwell in Fife (Robins et al. 2004); this was a story that was repeated throughout Europe and the Americas for hundreds of years. The story of Bath encapsulates the belief that groundwater is a healing agent. Several centuries after Prince Bladud’s experience, the Romans came upon the springs at Bath and, with their usual enthusiasm for hot springs, developed the site into the famous Roman baths that survive today. The baths prospered for four centuries before they fell into disrepair with the collapse of the Roman Empire. Interest was renewed from the late seventeenth century, when Bath became a fashionable resort tha

Balance training and multi-task performance in seniors

Age-related impairment in gait patterns when simultaneously performing cognitive (CI) and/or motor (MI) interference tasks are associated with an increased risk of falling in seniors. The objective of this study was to investigate the impact of balance training (BT) on walking performance with and without concurrently performing a CI and/or MI task in seniors. Twenty healthy women (n=14) and men (n=6) were assigned to either an intervention (n=11, age 71.9+/-4.8 yrs) or a control group (n=9, age 74.9+/-6.3 yrs). The intervention group conducted a six week BT (3/week). Pre and post tests included the assessment of stride-to-stride variability during single (walking), dual (CI or MI+walking), and triple (CI+MI+walking) task walking on an instrumented walkway. BT resulted in statistically significant reductions in stride time variability under single (p=0.02, Delta34.8%) but not dual or triple-task walking. Significant improvements in the MI task (p=0.05, Delta39.1%), but not in the CI task were found while walking. Findings showed that improved performance during single-task walking did not transfer to walking under dual or triple-task conditions suggesting multi-task BT as an alternative training modality. Improvement of the secondary motor but not cognitive task may indicate the need for the involvement of motor and particularly cognitive tasks during BT